No-Fault Case Law

The main issue in this case was whether the plaintiff, a health care provider, was entitled to summary judgment to recover first-party no-fault benefits for medical services rendered to its assignor. The court considered the fact that the plaintiff had submitted a claim for the medical services and that payment of the benefits was overdue. The defendant had timely denied the claim but had to submit proof in admissible form to rebut the plaintiff's prima facie showing. The court found that the defendant had raised a triable issue of fact as to whether it was provided with notice of the accident within 90 days as required by the insurance regulations. Therefore, the court affirmed the decision to deny the plaintiff's motion for summary judgment, as the defendant had sufficiently rebutted the plaintiff's showing.

The relevant facts considered by the court in this case were that the plaintiff filed a lawsuit to recover first-party no-fault benefits that were assigned to him by an injured party. The plaintiff was granted summary judgment, but the defendant appealed. The main issues decided in this case included whether the plaintiff had established entitlement to summary judgment, whether the defendant had failed to deny the claim within the required 30 days, and whether the defendant had provided sufficient proof of verification requests. The holding of the case was that the defendant did not raise a triable issue of fact and the plaintiff's motion for summary judgment was denied. The court also found that the defendant's untimely denial precluded certain defenses, but allowed the defendant to argue that the claim was based on treatment for medical conditions unrelated to a covered traffic incident.

The court considered an action to recover first-party no-fault benefits for medical services provided by the plaintiff to its assignor. The plaintiff established a prima facie entitlement to summary judgment by submitting a claim and showing that payment of benefits was overdue. When the defendant did not deny the claim within the statutory period, they were precluded from raising most defenses, including any deficiency in the assignments. However, the defendant was not precluded from asserting the defense that the collision was in furtherance of an insurance fraud scheme. The court found that the affidavit submitted by defendant's special investigator demonstrated a triable issue of fact as to whether there was a lack of coverage, leading to the denial of plaintiff's cross motion for summary judgment.

The court considered the fact that the plaintiff had not received a timely denial of their claim for no-fault benefits from the defendant insurance company, as required by Insurance Law § 5106(a). The main issue was whether the defendant had waived any defenses related to the medical necessity of the treatment and the sufficiency of the patient's assignment of benefits. The holding of the court was that the plaintiff was entitled to summary judgment on the complaint, as the defendant had waived defenses and failed to raise an issue of fact regarding the denial of coverage. The court reversed the order denying the plaintiff's motion for summary judgment, granted the motion, and remanded the matter to Civil Court for the assessment of appropriate attorney's fees and interest, as well as the entry of a judgment in favor of the plaintiff.

The court considered a case in which a health care provider sought recovery of first-party no-fault benefits for medical services rendered to its assignor. The provider established a prima facie entitlement to summary judgment by showing proof of the claims submitted and that payment of benefits was overdue. The defendant failed to pay or deny claims within the statutory period, leading to preclusion of most defenses with respect to those claims. However, remaining claims were timely denied on the grounds that the bills submitted were "not properly no-fault rated" and that the fees charged were in excess of the Workers' Compensation fee schedule. The court granted partial summary judgment to the plaintiff in the sum of $4,117.18 and remanded the matter for a calculation of the statutory interest and attorney's fees due, as well as for further proceedings on the remaining claims.

The relevant facts considered by the court were that the plaintiffs were seeking first-party no-fault benefits for medical services rendered to their assignor and had established a prima facie entitlement to summary judgment. The defendant had denied the plaintiffs' claims, asserting fraud and misrepresentation by the plaintiffs and their assignor. The main issue decided by the court was whether the defendant's delay in paying or denying the claim precluded them from raising certain defenses, and if they could assert a defense of fraud based on a belief that the injuries did not arise out of an insured incident. The holding of the court was that the plaintiffs' motion for summary judgment was granted, the complaint was reinstated, and the matter was remanded for a calculation of statutory interest and an assessment of attorney's fees. The entry of judgment was stayed for 45 days, with leave to the defendant to renew upon submission of proper papers within that period.

The main issue in the case was whether a licensed chiropractor was permitted to prescribe an MRI as a diagnostic tool under New York's No-Fault Insurance Law. The court had to consider whether an MRI prescribed by a licensed chiropractor for a part of the human body not within the chiropractor's licensed ability to treat was medically necessary and whether a medical supplier had a duty to investigate the authority of the prescribing doctor to write the prescription. The court analyzed the relevant provisions of the Education Law and precedent cases, and ultimately concluded that medical suppliers could generally recover first-party no-fault benefits for prescriptions for MRIs written by a licensed chiropractor. In this specific instance, the court found that the MRI was medically necessary and that the medical supplier was entitled to recovery for the services provided to the plaintiff's assignor. Based on this conclusion, the court held in favor of the plaintiff, awarding them $878.67 plus statutory interest, costs, and attorneys' fees.

The relevant facts that the court considered were a dispute over the "priority of payments" with State Farm arguing that it should not be 100% liable for first-party benefits solely based on its insured vehicle physically contacting an injured pedestrian. Lumbermens argued that the arbitrator's award was proper because there was no evidence of negligence on its insured driver's part. The main issue decided was whether the arbitrator's award was proper given the absence of proof of negligence on Lumbermens' part. The holding of the court was that the arbitrator's award was proper based on State Farm's failure to prove any negligence on the part of Lumbermens' insured driver, and even if the arbitrator misapplied applicable law, the award was not contrary to settled law and was not subject to vacatur under CPLR 7511(b)(1). Therefore, the court affirmed the judgment which denied State Farm's petition and dismissed the proceeding.

The main issue in this case was whether plaintiff was entitled to summary judgment to recover first-party no-fault benefits for medical supplies furnished to its assignor. Plaintiff established a prima facie entitlement to summary judgment by proving that it submitted a claim setting forth the fact and amount of the loss sustained, and that payment of no-fault benefits was overdue. Since the defendant failed to pay or deny the claim within the prescribed period, it was precluded from raising most defenses. However, defendant was not precluded from asserting the defense of insurance fraud, and demonstrated the existence of a triable issue of fact as to whether there was a lack of coverage. As a result, plaintiff's motion for summary judgment was properly denied. In addition, the defendant was not entitled to summary judgment based upon the plaintiff's assignor's nonattendance at scheduled examinations under oath.

The court considered the circumstances surrounding a default judgment entered against the defendant in an action to recover first-party no-fault benefits for medical services rendered to the plaintiffs' assignors. The main issue decided was whether the lower court had improvidently exercised its discretion in granting the defendant's motion to vacate the default judgment. The holding was that the lower court did not improvidently exercise its discretion in granting the defendant's motion to vacate the default judgment, and therefore the order was affirmed without costs.